Toria Gadson
Pompano Beach, Florida 33060
Home 954-***-**** or 754-***-****
abmq3l@r.postjobfree.com
Objective:
Seeking a challenging position that offers an opportunity for
personal and professional growth.
Work Experience:
7/08-Present
Promise Healthcare Inc-Revenue Analyst-
. Prepares weekly Medicare and Commercial cash projections for
all assigned facilities
. Audits and adjusts any discrepancies reported in cash projections
. Prepares weekly Case Management Reports for all assigned facilities
distributing to CEO, COO, Case Management, HIM and Admissions.
. Prepares weekly statistics on current month revenue.
. Maintains current working knowledge of governmental reimbursement
rules, regulations, and strategies to assist management at all levels
in all entities in dealing with governmental rules and regulations
. Conducts reviews and/or analysis of other financial data on an ad-hoc
basis. Compilation of the information could require extracting data
from several databases to enable complete and accurate information is
utilized. Analysis required will range from low to high level in
complexity.
. Communicates with the Director of Revenue Management to keep him/her
informed of day-to-day work activity as well as potential situations
that may arise
. Maintains a Working knowledge of all software, including, but
not limited to CPSI, Microsoft Word, Outlook, Microsoft,
Meditech, Medicare PC pricier, Internet Explorer, Ebos,
Direct Data Entry (DDE) and Code manger.
. Special Projects as assigned.
09/06-7/08
Promise Healthcare Inc-Billing Specialist-
. Work and update the Daily discharge log for account tracking.
. Responsible for billing and Collection of all Medicare and
Secondary commercial accounts as well as ensuring that the
claims are filed in a timely manner.
. Research denials, validity of questionable diagnosis codes,
procedure codes billable and inviolable revenue codes as well
as the above mentioned.
. Manage and work appeals, refunds and credit adjustments.
Assist with Bad debt reports.
. Maintains quality control of various reports to ensure proper
billing and collections of all accounts.
. Reviewed accounts and assigned those that require medical
records or further review.
. Assist in training of new hires on billing and system
policies and procedures.
. Maintains a Working knowledge of all software, including, but
not limited to CPSI, Microsoft Word, Outlook, Microsoft,
Meditech, Medicare PC pricier, Internet Explorer, Ebos,
Direct Data Entry (DDE) and Code manger.
01/05-8/06
Cymetrix (Out-source Vendor for Tenet Patient Financial Services)
Reimbursement & Adj Reconciler
. Handle work lists for 16 South Florida hospitals doing
Patient Transfer payments, Insurance transfer payments, and
high volume Payment research projects.
. Review patient accounts for duplicate or under-paid claims
and reconcile the patient accounts or process the payment to
the correct patient account.
. Request Patient Medical Records for unpaid claims and re-bill
to ensure payment unpaid claims.
. Audit accounts for coding and re-bill.
. Update or change invalid Payor codes to ensure proper
contract Reimbursement of claims.
. Liaison between out-source vendor and Tenet Regional Business
office for any data or claim/account corrections to resolve
patient accounts.
3/02-12/04
AHC Inc. Workers Comp/ Health Insurance CSR/ Collector Team
Leader/Senior Claims Rep
. Manage five or more collectors performing daily and monthly
review of accounts accuracy and job performance's.
. Maintained a work schedule of 100 or more accounts by
contacting insurance carrier, employer, and/or patients by
phone, mail or fax to ensure prompt resolution and payment of
medical bills or denied claims.
. Review UB 92, HCFA 1500, Medical Records, EOB, Contracts and
Itemized statements for accurate processing and filling of an
appeal to have a denial overturned.
. Request necessary information from AHC's client using forms
prepared in Microsoft Word of logs created in Microsoft
Excel.
. Maintains Working knowledge of all software, including, but
not limited to FACS, Microsoft Word, GroupWise, Microsoft
Internet Explorer and Code manger.
. Maintains a manageable work schedule through prioritization
of accounts and duties.
. Maintains confidentially of patient information at all times,
including but not limited to the medical records.
Education:
1998 graduate of Blanche Ely High School of Pompano Beach, Florida
Diploma 3.0 GPA
Reference upon
Request